Samudragupta Bora

Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children.

Background Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain. Objective Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years. Design/Methods The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998–2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning. Results At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk. Conclusions Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on their term MRI appear to be spared many of the cognitive impairments commonly associated with preterm birth. Further follow-up will be important to assess whether this finding persists into the school years.

Very preterm birth: maternal experiences of the neonatal intensive care environment

Objective:Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT).Study Design:Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development.Result:Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent–staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development.Conclusion:Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.

Neonatal cerebral morphometry and later risk of persistent inattention/hyperactivity in children born very preterm

BACKGROUND Attention problems are among the most prevalent neurobehavioral morbidities affecting very preterm (VPT) born children. The first study aim was to document rates of persistent attention/hyperactivity problems from ages 4 to 9 years in a regional cohort of VPT born children. The second aim was to examine the extent to which persistent problems were related to cerebral white matter abnormality and structural development on neonatal MRI. METHODS Data were drawn from a prospective longitudinal study of 110 VPT (≤32 weeks gestation) and 113 full-term (FT) children born from 1998 to 2000. At term equivalent, all VPT and 10 FT children underwent cerebral structural MRI, with scans analyzed qualitatively for white matter abnormalities and quantitatively for cortical and subcortical gray matter, myelinated and unmyelinated white matter, and cerebrospinal fluid volumes. At ages 4, 6, and 9 years, each childs parent and teacher completed the Inattention/Hyperactivity subscale of the Strengths and Difficulties Questionnaire. RESULTS VPT born children had a fivefold increased risk of persistent attention/hyperactivity problems compared with FT children (13.1% vs. 2.8%; p = .002). No association was found between neonatal white matter abnormalities and later persistent inattention/hyperactivity risk (p ≥ .24). In contrast, measures of cerebral structural development including volumetric estimates of total cerebral tissue and cerebrospinal fluid relative to intracranial volume were associated with an increased risk of persistent attention/hyperactivity problems in VPT born children (p = .001). The dorsal prefrontal region showed the largest volumetric reduction (↓3.2-8.2 mL). These brain-behavior associations persisted and in some cases, strengthened after covariate adjustment for postmenstrual age at MRI, gender, and family socioeconomic status. CONCLUSIONS Just over one in 10 VPT born children are subject to early onset and persistent attention/hyperactivity problems during childhood. These problems appear to reflect, at least in part, neonatal disturbances in cerebral growth and development rather than the effects of white matter injury.

Identifying Very Preterm Children at Educational Risk Using a School Readiness Framework

OBJECTIVES: Children born very preterm (VPT) are at high risk of educational delay, yet few guidelines exist for the early identification of those at greatest risk. Using a school readiness framework, this study examined relations between preschool neurodevelopmental functioning and educational outcomes to age 9 years. METHODS: The sample consisted of a regional cohort of 110 VPT (≤32 weeks’ gestation) and 113 full-term children born during 1998–2000. At corrected age 4 years, children completed a multidisciplinary assessment of their health/motor development, socioemotional adjustment, core learning skills, language, and general cognition. At ages 6 and 9, children’s literacy and numeracy skills were assessed using the Woodcock-Johnson III Tests of Achievement. RESULTS: Across all readiness domains, VPT children were at high risk of delay/impairment (odds ratios 2.5–3.5). Multiple problems were also more common (47% vs 16%). At follow-up, almost two-thirds of VPT children were subject to significant educational delay in either literacy, numeracy or both compared with 29% to 31% of full-term children (odds ratios 3.4–4.4). The number of readiness domains affected at age 4 strongly predicted later educational risk, especially when multiple problems were present. Receiver operating characteristic analysis confirmed ≥2 readiness problems as the optimal threshold for identifying VPT children at educational risk. CONCLUSIONS: School readiness offers a promising framework for the early identification of VPT children at high educational risk. Findings support the utility of ≥2 affected readiness domains as an effective criterion for referral for educational surveillance and/or additional support during the transition to school.

Emotional and behavioural adjustment of children born very preterm at early school age.

Aims:  This paper describes the emotional and behavioural adjustment of children born very preterm (VPT) at early school age. Of particular interest was the degree of agreement between parents and teachers, and the extent of situational (parent or teacher) and pervasive (parent and teacher reported) adjustment problems.

Social development of children born very preterm: a systematic review

To review systematically studies examining the development of social competence in children born very preterm (VPT) (gestation <33wks) and identify neonatal and family predictors.

Attention and regional gray matter development in very preterm children at age 12 years

OBJECTIVES This study examines the selective, sustained, and executive attention abilities of very preterm (VPT) born children in relation to concurrent structural magnetic resonance imaging (MRI) measures of regional gray matter development at age 12 years. METHODS A regional cohort of 110 VPT (≤32 weeks gestation) and 113 full term (FT) born children were assessed at corrected age 12 years on the Test of Everyday Attention-Children. They also had a structural MRI scan that was subsequently analyzed using voxel-based morphometry to quantify regional between-group differences in cerebral gray matter development, which were then related to attention measures using multivariate methods. RESULTS VPT children obtained similar selective (p=.85), but poorer sustained (p=.02) and executive attention (p=.01) scores than FT children. VPT children were also characterized by reduced gray matter in the bilateral parietal, temporal, prefrontal and posterior cingulate cortices, bilateral thalami, and left hippocampus; and increased gray matter in the occipital and anterior cingulate cortices (family-wise error-corrected p<.05). Poorer sustained auditory attention was associated with increased gray matter in the anterior cingulate cortex (p=.04). Poor executive shifting attention was associated with reduced gray matter in the right superior temporal cortex (p=.04) and bilateral thalami (p=.05). Poorer executive divided attention was associated with reduced gray matter in the occipital (p=.001), posterior cingulate (p=.02), and left temporal (p=.01) cortices; and increased gray matter in the anterior cingulate cortex (p=.001). CONCLUSIONS Disturbances in regional gray matter development appear to contribute, at least in part, to the poorer attentional performance of VPT children at school age. (JINS, 2017, 23, 539-550).

Peer Relationship Outcomes of School-Age Children Born Very Preterm

Objectives To characterize the friendship networks, peer relationships, and bullying experiences of 12‐year‐old children born extremely preterm (EPT; 23‐27 weeks of gestation), very preterm (VPT; 28‐32 weeks of gestation), and full term (FT; 38‐41 weeks of gestation), and to identify child characteristics placing children at risk of peer problems. Study design A regional cohort of 44 EPT, 60 VPT, and 109 FT born children were followed prospectively to 12 years of age. The nature of childrens close friendships, peer relations, and bullying experiences were assessed using a multimethod approach, including parent, teacher, and child report. Results Across all measures, children born EPT had more peer social difficulties than children born VPT and FT. They were more likely to report no close friendships (5%‐14% EPT vs 0%‐3% VPT/FT), dissatisfaction with their peer network (16% vs 1%‐2%), and less time interacting face‐to‐face with friends (16%‐23% vs 5%‐8%). They were also 3 times more likely to be rated by their parents and teachers as experiencing problems relating to peers (P ≤ .001). In contrast, rates of chronic bullying (≥2 times/week) were similar for EPT and VPT children (12%‐14% vs 4% FT). Emotional problems, inattention/hyperactivity, and motor deficits were associated with an increased risk of peer relationship problems, whereas higher body mass index, delayed pubertal development, vision problems, and inattention/hyperactivity problems were associated with frequent bullying. Conclusions With the exception of bullying, risks of peer social difficulties were greatest among children born EPT. Peer social relationships should be monitored as part of longer term developmental surveillance and support.

Altered functional network connectivity relates to motor development in children born very preterm

&NA; Individuals born very preterm (<32 weeks gestation) are at increased risk for neuromotor impairments. The ability to characterize the structural and functional mechanisms underlying these impairments remains limited using existing neuroimaging techniques. Resting state‐functional magnetic resonance imaging (rs‐fMRI) holds promise for defining the functional network architecture of the developing brain in relation to typical and aberrant neurodevelopment. In 58 very preterm and 65 term‐born children studied from birth to age 12 years, we examined relations between functional connectivity measures from low‐motion rs‐fMRI data and motor skills assessed using the Movement Assessment Battery for Children, 2nd edition. Across all subscales, motor performance was better in term than very preterm children. Examination of relations between functional connectivity and motor measures using enrichment analysis revealed between‐group differences within cerebellar, frontoparietal, and default mode networks, and between basal ganglia‐motor, thalamus‐motor, basal ganglia‐auditory, and dorsal attention‐default mode networks. Specifically, very preterm children exhibited weaker associations between motor scores and thalamus‐motor and basal ganglia‐motor network connectivity. These findings highlight key functional brain systems underlying motor development. They also demonstrate persisting developmental effects of preterm birth on functional connectivity and motor performance in childhood, providing evidence for an alternative network architecture supporting motor function in preterm children.